Ghép mạch Femorotibial bằng Polytetrafluoroethylene: Tỷ lệ thuyên giảm và bảo tồn chi sau 5 năm

Annals of Vascular Surgery - Tập 17 - Trang 486-491 - 2003
P. Klinkert1, P. J. E. van Dijk1, P. J. Breslau1
1Department of Vascular Surgery, Red Cross Hospital, The Hague, The Netherlands

Tóm tắt

Đối với ghép mạch fémorotibial, vật liệu được lựa chọn là tĩnh mạch tự thân. Câu hỏi đặt ra là liệu vật liệu prosthetic có phải là một lựa chọn hợp lý cho việc bảo tồn chi, nếu không có tĩnh mạch tự thân. Từ năm 1991 đến 1998, 83 thủ thuật bắc cầu femorotibial liên tiếp đã được thực hiện trên 70 bệnh nhân. Polytetrafluoroethylene (PTFE) 6mm thành mỏng, có hình dạng vòng đã được sử dụng, vì không có tĩnh mạch tự thân. Chỉ định cho việc bắc cầu femorotibial là thiếu máu cục bộ nghiêm trọng do bệnh lý xơ vữa động mạch trong tất cả các trường hợp. Ba bệnh nhân đã qua đời trong bệnh viện hoặc trong vòng 30 ngày sau phẫu thuật, dẫn đến tỷ lệ tử vong trong phẫu thuật là 3.6%. Sau 5 năm, 33 bệnh nhân đã qua đời (40%) và 3 bệnh nhân mất liên lạc (3.6%). Tỷ lệ thông suốt sơ cấp là 64.2% sau 6 tuần và 18% ± 5% sau 5 năm. Tỷ lệ thông suốt thứ cấp là 74.1% sau 6 tuần và 22.3% ± 6% sau 5 năm. Khi so sánh tỷ lệ thông suốt sơ cấp và thứ cấp cho các mạch nối xa, không có sự khác biệt giữa ba động mạch cẳng chân. Tỷ lệ bảo tồn chi là 61.9% ± 7% sau 5 năm. Từ những kết quả này, chúng tôi kết luận rằng, với tỷ lệ bảo tồn chi là 61.9%, PTFE là một lựa chọn có thể chấp nhận cho ghép mạch femorotibial ở bệnh nhân có thiếu máu cục bộ nghiêm trọng, nếu không có tĩnh mạch tự thân.

Từ khóa

#ghép mạch #polytetrafluoroethylene #bảo tồn chi #phẫu thuật #thiếu máu cục bộ

Tài liệu tham khảo

RW Hobson TG Lynch Z Jamil et al. (1985) ArticleTitleResults of revascularization and amputation in severe lower extremity ischemia: a five-year clinical experience. J Vasc Surg 2 174–185 Occurrence Handle10.1067/mva.1985.avs0020174 Occurrence Handle3965750 J Sipponen K Ala-Kulju P Ketonen et al. (1989) ArticleTitleFemorotibial bypass grafting for lower limb ischaemia. Int Angiol 8 65–69 Occurrence Handle1:STN:280:By%2BD3sfnvVQ%3D Occurrence Handle2809333 RJ Stoney (1978) ArticleTitleUltimate salvage for the patient with limb-threatening ischemia. Realistic goals and surgical considerations. Am J Surg 136 228–232 Occurrence Handle1:STN:280:CSeB2MvmsFI%3D Occurrence Handle686269 RA Yeager RW Hobson Z Jamil TG Lynch BC Lee K Jain (1982) ArticleTitleDifferential patency and limb salvage for polytetrafluoroethylene and autogenous saphenous vein in severe lower extremity ischemia. Surgery 91 99–103 Occurrence Handle1:STN:280:Bi2C3cfisVU%3D Occurrence Handle7054913 PR Bell (1985) ArticleTitleAre distal vascular procedures worthwhile? Br J Surg 72 335 Occurrence Handle1:STN:280:BiqB3c%2FlvFY%3D Occurrence Handle3995237 JJ Bergan FJ Veith VM Bernhard et al. (1982) ArticleTitleRandomization of autogenous vein and polytetrafluorethylene grafts in femoral-distal reconstruction. Surgery 92 921–930 Occurrence Handle1:STN:280:BiyD28fhsFQ%3D Occurrence Handle6755789 FJ Veith SK Gupta RH Samson et al. (1981) ArticleTitleProgress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedures. Ann Surg 94 386–401 JH Wolfe MR Tyrrell (1991) ArticleTitleJustifying arterial reconstruction to crural vessels—even with a prosthetic graft. Br J Surg 78 897–899 Occurrence Handle1:STN:280:By2D3cvmsVM%3D Occurrence Handle1913101 RE Parsons WD Suggs FJ Veith et al. (1996) ArticleTitlePolytetrafluoroethylene bypasses to infrapopliteal arteries without cuffs or patches: a better option than amputation in patients without autologous vein. J Vasc Surg 23 347–354 Occurrence Handle1:STN:280:BymC1MrhvVY%3D Occurrence Handle8637113 M Belkin J Knox MC Donaldson JA Mannick AD Whittemore (1996) ArticleTitleInfrainguinal arterial reconstruction with nonreversed greater saphenous vein. J Vasc Surg 24 957–962 Occurrence Handle1:STN:280:ByiC3s%2FlvVI%3D Occurrence Handle8976349 LM Taylor Jr JM Edwards JM Porter (1990) ArticleTitlePresent status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg 11 193–205 Occurrence Handle10.1067/mva.1990.17235 Occurrence Handle1:STN:280:By%2BC3svht1E%3D Occurrence Handle2299743 DM Shah RC Darling III BB Chang KM Fitzgerald PS Paty RP Leather (1995) ArticleTitleLong-term results of in situ saphenous vein bypass. Analysis of 2058 cases. Ann Surg 222 438–446 Occurrence Handle7574925 FJ Veith SK Gupta E Ascer et al. (1986) ArticleTitleSix-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg 3 104–114 JD Balshi NL Cantelmo JO Menzoian FW Logerfo (1989) ArticleTitleThe use of arm veins for infrainguinal bypass in end-stage peripheral vascular disease. Arch Surg 124 1078–1081 Occurrence Handle1:STN:280:BiaA2szlvFQ%3D Occurrence Handle2774911 TJ Holzenbein FB Pomposelli Jr Miller A et al. (1996) ArticleTitleResults of a policy with arm veins used as the first alternative to an unavailable ipsilateral greater saphenous vein for infrainguinal bypass. J Vasc Surg 23 130–140 Occurrence Handle1:STN:280:BymC2M3jsVQ%3D Occurrence Handle8558728 GL Londrey LP Bosher PW Brown FD Stoneburner Jr JW Pancoast RK Davis (1994) ArticleTitleInfrainguinal reconstruction with arm vein, lesser saphenous vein, and remnants of greater saphenous vein: a report of 257 cases. J Vasc Surg 20 451–456 Occurrence Handle1:STN:280:ByuA28ngtFY%3D Occurrence Handle8084039 PL Faries FW Logerfo S Arora et al. (2000) ArticleTitleArm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization. J Vasc Surg 31 1119–1127 Occurrence Handle10.1067/mva.2000.106488 Occurrence Handle1:STN:280:DC%2BD3czgt12nug%3D%3D Occurrence Handle10842148 AT Gentile RW Lee GL Moneta LM Taylor JM Edwards JM Porter (1996) ArticleTitleResults of bypass to the popliteal and tibial arteries with alternative sources of autogenous vein. J Vasc Surg 23 272–279 Occurrence Handle1:STN:280:BymC1Mrhslc%3D Occurrence Handle8637104 RW Harris G Andros SX Salles-Cunha LB Dulawa RW Oblath RL Apyan (1986) ArticleTitleTotally autogenous venovenous composite bypass grafts. Salvage of the almost irretrievable extremity. Arch Surg 121 1128–1132 Occurrence Handle1:STN:280:BiiD38rhtFE%3D Occurrence Handle3767645 RW Hobson JA O’Donnell Z Jamil K Mehta (1980) ArticleTitleBelow-knee bypass for limb salvage. Comparison of autogenous saphenous vein, polytetrafluoroethylene, and composite dacron-autogenous vein grafts. Arch Surg 115 833–837 Occurrence Handle6446269 GL Londrey DE Ramsey KJ Hodgson LD Barkmeier DS Sumner (1991) ArticleTitleInfrapopliteal bypass for severe ischemia: comparison of autogenous vein, composite, and prosthetic grafts. J Vasc Surg 13 631–636 Occurrence Handle10.1067/mva.1991.28208 Occurrence Handle1:STN:280:By6B38ngsVA%3D Occurrence Handle2027201 InstitutionalAuthorNameComparative evaluation of prosthetic, reversed, and in situ vein bypass grafts in distal popliteal and tibial-peroneal revascularization. (1988) ArticleTitleVeterans Administration Cooperative Study Group 141. Arch Surg 123 434–438 H Dardik (1995) ArticleTitleThe second decade of experience with the umbilical vein graft for lower-limb revascularization. Cardiovasc Surg 3 265–269 JH Miller RK Foreman L Ferguson I Faris (1984) ArticleTitleInterposition vein cuff for anastomosis of prosthesis to small artery. Aust N Z J Surg 54 283–285 Occurrence Handle1:STN:280:BiuB2sbot1U%3D Occurrence Handle6380479 JM Fichelle J Marzelle G Colacchio F Gigou F Cormier JM Cormier (1995) ArticleTitleInfrapopliteal polytetrafluoroethylene and composite bypass: factors influencing patency. Ann Vasc Surg 9 187–196 Occurrence Handle1:STN:280:ByqA3cnivVQ%3D Occurrence Handle7786705 RS Taylor A Loh RJ McFarland M Cox JF Chester (1992) ArticleTitleImproved technique for polytetrafluoroethylene bypass grafting: long-term results using anastomotic vein patches. Br J Surg 79 348–354 Occurrence Handle1:STN:280:By2B2cfktFY%3D Occurrence Handle1576506 RI Rückert U Settmacher U Kruger H Scholz (2000) ArticleTitleFemorodistal PTFE bypass grafting for severe limb ischaemia: results of a prospective clinical study using a new distal anastomotic technique. Eur J Vasc Endovasc Surg 20 51–56 Occurrence Handle10.1053/ejvs.2000.1119 Occurrence Handle1:STN:280:DC%2BD3cvgtF2ntw%3D%3D Occurrence Handle10906298 AP Moody S al Fagih PR Edwards H Campbell PL Harris (1991) ArticleTitleThe use of an adjuvant arterio-venous shunt in prosthetic femoro-crural bypass. Eur J Vasc Surg 5 327–332 Occurrence Handle1:STN:280:By6A38zls1U%3D Occurrence Handle1864397 A Hamsho D Nott PL Harris (1999) ArticleTitleProspective randomised trial of distal arteriovenous fistula as an adjunct to femoro-infrapopliteal PTFE bypass. Eur J Vasc Endovasc Surg 17 197–201 Occurrence Handle10.1053/ejvs.1998.0671 Occurrence Handle1:STN:280:DyaK1M7pt1ymsg%3D%3D Occurrence Handle10092890 RB Rutherford DP Flanigan SK Gupta et al. (1986) ArticleTitleSuggested standards for reports dealing with lower extremity ischemia. J Vasc Surg 4 80–94 Occurrence Handle10.1067/mva.1986.avs0040080 Occurrence Handle3723692 RB Rutherford JD Baker C Ernst et al. (1997) ArticleTitleRecommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26 517–538 Occurrence Handle1:STN:280:ByiH2Mzpslw%3D Occurrence Handle9308598 WJ Quinones-Baldrich AA Prego R Ucelay-Gomez et al. (1992) ArticleTitleLong-term results of infrainguinal revascularization with polytetrafluoroethylene: a ten-year experience. J Vasc Surg 16 209–217 Occurrence Handle10.1067/mva.1992.36524 Occurrence Handle1495144 H Schweiger P Klein W Lang (1993) ArticleTitleTibial bypass grafting for limb salvage with ringed polytetrafluoroethylene prostheses: results of primary and secondary procedures. J Vasc Surg 18 867–874 Occurrence Handle10.1067/mva.1993.45284 Occurrence Handle1:STN:280:ByuD2cjkvFc%3D Occurrence Handle8230575 AD Whittemore KC Kent MC Donaldson NP Couch JA Mannick (1989) ArticleTitleWhat is the proper role of polytetrafluoroethylene grafts in infrainguinal reconstruction? J Vasc Surg 10 299–305 Occurrence Handle10.1067/mva.1989.14116 Occurrence Handle1:STN:280:BiaA1c3otFc%3D Occurrence Handle2778894 RF Neville B Tempesta AN Sidway (2001) ArticleTitleTibial bypass for limb salvage using polytetrafluoroethylene and a distal vein patch. J Vasc Surg 33 266–271 Occurrence Handle10.1067/mva.2001.113131 Occurrence Handle1:STN:280:DC%2BD3M7lslyksA%3D%3D Occurrence Handle11174777